Filgrastim-Stimulated Bone Marrow Compared with Filgrastim-Mobilized Peripheral Blood in Myeloablative Sibling Allografting for Patients with Hematologic Malignancies: A Randomized Canadian Blood and Marrow Transplant Group Study

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• 作者：Stephen Couban¹ ; ^{stephen.couban@nshealth.ca" class="auth_mail" title="E-mail the corresponding author} ; Mahmoud Aljurf² ; Sylvie Lachance³ ; Irwin Walker⁴ ; Cynthia Toze⁵ ; Morel Rubinger⁶ ; ^&dagger ; ; Jeffrey H. Lipton⁷ ; Stephanie J. Lee⁸ ; Richard Szer⁹ ; R. Doocey¹⁰ ; Ian D. Lewis¹¹ ; Lothar Huebsch¹² ; Kang Howson-Jan¹³ ; Michel Lalancette¹⁴ ; Fahad Almohareb² ; Nadeem Chaudhri² ; Sabine Ivison¹⁵ ; Raewyn Broady⁵ ; Megan Levings¹⁵ ; Diane Fairclough¹⁶ ; Gerald Devins⁷ ; David Szwajcer⁶ ; Ronan Foley⁴ ; Clayton Smith¹⁶ ; Tony Panzarella⁷ ; Holly Kerr⁵ ; Amina Kariminia¹⁵ ; Kirk R. Schultz¹⁵
• 关键词：Filgrastim ; Blood and marrow transplantation ; Hematopoietic cell transplantation ; Donor source ; Graft-versus-host disease ; Mobilized bone marrow
• 刊名：Biology of Blood and Marrow Transplantation
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：22
• 期：8
• 页码：1410-1415
• 全文大小：569 K

文摘

In adult hematopoietic cell transplantation (HCT), filgrastim-mobilized peripheral blood (G-PB) has largely replaced unstimulated marrow for allografting. Although the use of G-PB results in faster hematopoietic recovery, it is also associated with more chronic graft-versus-host disease (cGVHD). A potential alternative allograft is filgrastim-stimulated marrow (G-BM), which we hypothesized may be associated with prompt hematopoietic recovery but with less cGVHD. We conducted a phase 3, open-label, multicenter randomized trial of 230 adults with hematologic malignancies receiving allografts from siblings after myeloablative conditioning to compare G-PB with G-BM. The primary endpoint was time to treatment failure, defined as a composite of extensive cGVHD, relapse/disease progression, and death. With a median follow-up of 36 months (range, 9.6 to 48), comparing G-BM with G-PB, there was no difference between the 2 arms with respect to the primary outcome of this study (hazard ratio [HR], .91; 95% confidence interval [CI], .68 to 1.22; P = .52). However, the cumulative incidence of overall cGVHD was lower with G-BM (HR, .66; 95% CI, .46 to .95; P = .007) and there was no difference in the risk of relapse or progression (P = .35). The median times to neutrophil recovery (P = .0004) and platelet recovery (P = .012) were 3 days shorter for recipients allocated to G-PB compared with those allocated to G-BM, but there were no differences in secondary engraftment-related outcomes, such as time to first hospital discharge (P = .17). In addition, there were no graft failures in either arm. This trial demonstrates that, compared with G-PB, the use of G-BM allografts leads to a significantly lower rate of overall cGVHD without a loss of the graft-versus-tumor effect and comparable overall survival. Our findings suggest that further study of this type of allograft is warranted.